全麻诱导期连续无创血压监测系统T-line300对麻醉医生临床决策影响

The effect of T-line300continuous noninvasive blood pressure monitoring system on anesthesiologists’ clinical decision-making during induction of general anesthesia

目的 评价全麻诱导期T-line300系统所测连续无创血压对医生决策处理影响的可靠性。方法 纳入择期手术需进行全身麻醉的患者60例,ASA II-Ⅲ级。麻醉诱导前无菌操作下动脉导管置入一侧桡动脉内行有创血压监测,另一侧手臂连T-line300系统行无创连续血压监测,血压稳定后间隔15s记录一次两种方式所测的收缩压(SBP)和平均动脉压(MAP)。将每隔15s监测的血压值视为一个处理决策点,以SBP波动超过稳定后T0时刻的基础血压20%上下限、MAP超过65-150mmHg区间需进行决策处理为原则,分别记录每个处理决策点麻醉医生根据两种血压监测方式所测SBP和MAP作出的决策表现,并以有创连续血压监测结果为金标准构建诊断准确性模型,金标准规定的需要进行处理的决策点为“阳性”决策点,反之为“阴性”决策点。结果 T-line300对金标准确定的“阳性”和“阴性”决策点的诊断结果SBP:敏感度0.759,特异度0.846,ROC曲线下面积0.803(95%置信区间:0.779-0.826);MAP:敏感度0.576,特异度0.965,ROC曲线下面积0.770(95%置信区间:0.727-0.814),P<0.01。结论与有创连续血压监测相比,无创连续T-line300系统可在全麻诱导期间异常血压波动的关键节点较好地辅助麻醉医生作出临床决策。

Objective To evaluate the reliability of continuous noninvasive blood pressure measured by T-line300system during induction of general anesthesia on decision-making.Methods Sixty patients(ASA II-III)who underwent general anesthesia were included in this study.Invasive blood pressure monitoring was performed in one radial artery by placing arterial catheter in aseptic operation before induction of anesthesia,and non-invasive continuous blood pressure monitoring was performed in the other arm with T-line300system.Systolic blood pressure(SBP)and mean arterial pressure(MAP)measured were recorded at intervals of 15safter blood pressure was stabilized.Blood pressure values monitored every 15swere marked as a decision-making point.When SBP fluctuation exceeded the upper and lower limits of 20% of basal blood pressure at T0after stabilization of blood pressure or MAP exceeded the range of 65-150mmHg,decision-making process was required.The anesthesiologist’s decision performance at each decision-making point was recorded based on SBP and MAP measured by both blood pressure monitoring methods.Subsequently,a diagnostic accuracy model was constructed based on the results of invasive continuous blood pressure monitoring as the gold standard,and the decision points requiring blood pressure adjustment as stipulated in the gold standard were“positive”decision points,otherwise,“negative”decision points.Results Compared with gold standard invasive monitoring method,the result of“positive”and“negative”decision points detected by T-line300were as follows:the sensitivity,specificity and receiver operating characteristic(ROC)curve of SBP were 0.759,0.846,0.803(95% confidence interval0.779-0.826),respectively;the sensitivity,specificity and receiver operating characteristic(ROC)curve of MAP were0.576,0.965,0.770(95%confidence interval:0.727-0.814),P<0.01.Conclusion Compared with invasive continuous blood pressure monitoring,the non-invasive continuous T-line300system can assist anesthesiologists to make clinical decisions at key points of abnormal blood pressure fluctuations during induction of general anesthesia.